Surgery offers the best chances of long-term survival for mesothelioma patients. Early-stage patients are the best candidates for surgery. However, patients in all stages of mesothelioma may be eligible. If you aren’t given surgery as an option, consider talking to another doctor. A second opinion from a mesothelioma specialist can save a life.
Doctors have developed different surgical procedures for treating each mesothelioma location.
Here are the main surgical treatments available for many mesothelioma patients:
- Extrapleural pneumonectomy (EPP) for pleural mesothelioma
- Pleurectomy with decortication (P/D) for pleural mesothelioma
- Cytoreduction with HIPEC for peritoneal mesothelioma
- Pericardiectomy for pericardial mesothelioma
- Palliative surgeries for all mesothelioma types
Extrapleural pneumonectomy (EPP) is a surgery used to treat pleural mesothelioma. During the EPP, the mesothelioma surgeon removes the diseased lung and parts of the chest lining and the heart lining (pericardium). The doctor may also remove a portion of the diaphragm and/or nearby lymph nodes.
Early-stage patients (stage 1 and 2) often receive EPP because of its potential for success. But pleural mesothelioma patients in stages 3 or 4 have benefitted from this treatment too.
The EPP removes the diseased lung and parts of the chest cavity where the cancer has spread. Removing the lung where the majority of the cells exist can improve a patient’s life expectancy.
Did you know?
On average, a patient can double their life expectancy from 12 to 24 months with an EPP. Some patients have gone on to live 5 or more years due to their EPP surgery.
The late Dr. David Sugarbaker was a pioneer for the EPP for pleural mesothelioma. He spent the last 30 years of his life developing this surgery so that more patients can benefit from it. Experts believe survival rates will only continue to improve as specialists refine the EPP technique and increase its success rate.
Pleurectomy With Decortication
Pleurectomy with decortication (P/D) is a used to treat pleural mesothelioma keep their lung. Since it is a lung-sparing surgery, some consider P/D to be a better option compared to EPP.
P/D involves a two-part surgery:
- The surgeon performs the “pleurectomy” — removing the diseased pleura (lung lining).
- The surgeon begins the “decortication” — removing visible tumor masses in the chest cavity.
Only candidates who are in good enough health to withstand surgery are eligible to receive a P/D. Like EPP, P/D is typically performed on early-stage pleural mesothelioma patients. However, some advanced-stage patients are candidates for P/D.
Dr. Robert Cameron of the UCLA Medical Center developed P/D as an alternative to EPP. Dr. Cameron has spent more than two decades refining the procedure to ensure greater rates of success. As surgeons continue to perfect P/D, they can increase survival rates and save more patient lives.
Visit the UCLA Health website to learn more about Dr. Robert Cameron.
The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.
Though each surgical technique has passionate proponents on either side, EPP and P/D have both proven to improve patient life expectancy significantly. Like the EPP, P/D also doubles the average patient life expectancy.
Cytoreduction with HIPEC is the only surgical procedure for peritoneal mesothelioma.
It’s a two-part surgical procedure consisting of:
- Cytoreduction: First, the surgeon uses a surgical technique called cytoreduction. The surgeon removes as much of the visible tumors as possible, as well as removing the diseased peritoneum (peritonectomy) — the lining of the abdominal cavity.
- HIPEC: The surgeon then applies hyperthermic intraoperative chemotherapy (HIPEC) — circulating heated chemotherapy drugs in the abdomen. HIPEC helps kill off any remaining mesothelioma cells in the abdomen. Dr. Paul Sugarbaker developed this operation for peritoneal mesothelioma.
Did you know?
Cytoreduction with HIPEC has resulted in an average life expectancy of three years for patients.
Pericardiectomy is used to treat pericardial mesothelioma. During a pericardiectomy, the surgeon removes part or all of the diseased pericardium, the lining of the heart.
Combining a pericardiectomy with chemotherapy has allowed some patients to live longer than three years after their diagnosis.
A pericardiectomy may be used as a treatment surgery or a palliative surgery to help alleviate painful symptoms like difficulty breathing. In some cases, a pericardiectomy has extended a patient’s life expectancy significantly.
Palliative surgeries help increase comfort levels by alleviating symptoms. There are many types of palliative surgeries, depending on the mesothelioma location.
Most palliative surgeries involve removing parts of the diseased mesothelium and draining fluid buildup. Draining fluid helps patients by reducing their swelling and eliminating tightness in their chest or abdomen. This allows them to breathe comfortably.
Palliative surgeries don’t usually extend life expectancy, but they can help mesothelioma patients live without pain and discomfort.
Here are the different palliative surgical options:
- Pleurodesis: Prevents fluid buildup in the pleura
- Thoracentesis: Removes excess fluid between the lungs and the pleura
- Pericardiocentesis: Empties excess fluid in the pericardium
Mesothelioma specialists are the only ones who can adequately determine whether a patient is a good candidate for curative surgeries or palliative surgeries.